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SITE ADDRESS <br />LE� / LOT N0. <br />DESC. <br />OW NER <br />'�� I.L.f7�i.-�C <br />TENANTNAME <br />PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �- a6 -� j <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PEFiM1T <br />7� <br />PHONE zb(� � 6j3 � f52Z <br />_I`JIfJ��J Y.�V��IG�J' � G�ZGG ��I�AHflK�i E•MAIL.,T� `QJ�NcS�oIKAHPK�� <br />CONTRACT(TR— ADDRESS CITY2IP PHO L- <br />,n2zS�����c� �p�.r,�z3�h , sur�,��,�t�:�=�i� z53 z5-a� t39�t- <br />CONTR. LICENSE # A 2ZZ�S,�GQ3�-� � <br />USE OF BUILDING <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />CONTRACT PRICE OF 1VORK <br />Z�7 � C::c�c7 <br />WURKDESCRiPT10N � i�s , ����T�� �N.�������i�� <br />y��r-tu EycY�Tl� iaa-+' IS����-�'i (��� T <br />j$Iwi��6 At�7C(ct�t� ��12G 5G—('j-1�t761J A"L C�IS�j�Kn �."�-Nis�r—�, I�FT�7��s—Y-�, <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Ba�h�ub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Water heater <br />Sink (service/bar <br />Backllow pmvenl� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Furced air syslems <br />Gas piping <br />Water heater <br />Gas lirep�ace <br />asrange <br />lolhes dryer <br />�Rang�;hood <br />IExhaust fan <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALcS TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined �his application and know the same to he irue and correct. AII provisions ot laws and <br />ordinaces governinc� this type of work will be complied with whelher specified herein or not. The granling of a permit does not pre�ume <br />lo give aulhorily to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />conslruc' n. That� in�ulhorize� e own�� ProPedy to pedorm the work for which application is made and I comply with the <br />State oniraclors Cv 1 B)27 RCW and 296.2G0 p <br />�/JDo D �.� %' �7•CJ�6 <br />��� <br />